Coding Quality Review Auditor (Remote)

Adventist Health•Roseville, CA

2h•Remote

About The Position

This role performs quality reviews and audits to ensure compliance with DRG validation, ICD-10/PCS, and CPT coding guidelines. The auditor will coordinate with department leadership to ensure standards are met in accordance with department and organization policy, and contribute to improving the processes and infrastructure of the department. The position requires proficiency in facilitation, interpersonal communication, organizational skills, prioritization, professionalism, and educating/training. The auditor will use an in-depth understanding of the CQR quality workplan to promote compliance and awareness, acting as a subject matter expert (SME) in national coding guidelines for hospital inpatient, outpatient, and/or Professional fee coding. The role ensures compliance with these guidelines and all company coding policies. Performance improvement analyses will be used to improve the accuracy, integrity, and quality of patient data, ensure minimal variation in coding practices, and improve the quality of physician documentation to support code assignments, resulting in appropriate reimbursement and data integrity.

Requirements

High School Education/GED or equivalent: Required
Five years' acute care inpatient, outpatient coding experience, and/or professional fee coding: Required
Certified Coding Specialist credential (CCS) through AHIMA or AAPC; credential type specific to auditing being performed.: Required

Nice To Haves

Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred
Three years' coding auditing/monitoring experience: Preferred

Responsibilities

Performs regularly scheduled quality reviews and audits per departmental policies and procedures (routine, pre-bill, policy driven, targeted, and post-bill) for hospital inpatient, outpatient, and/or professional fee coding.
Facilitates the coder audit appeal process, providing rationale and education to the coding team as required.
Performs ad hoc quality reviews, such as targeted DRG reviews, and special projects as assigned by management.
Prepares detailed audit reports outlining findings, recommendations, rationale, and corrective actions needed.
Assists team members with coding questions and provide resolution guidance.
Assists in ensuring coding staff adherence with coding guidelines and policy, both internal and vendor teams.
Demonstrates and applies expert level knowledge of medical coding practices and concepts.
Communicates appropriately with manager and all stakeholders as required.
Identifies and communicates educational opportunities to manager.
Maintains working knowledge of workflows, systems, and tools used in the department.
Reviews all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current.
Maintains up-to-date knowledge of medical terminology, coding guidelines, quality standards, regulatory changes, etc. that affect the audit process.
Assists in creation and maintenance of a positive working environment, including effective communication and setting an appropriate professional example.
Performs other job-related duties as assigned.